Strut graft vs. traditional plating in the management of periprosthetic humeral fractures: a multicentric cohort study.

Aim The gradual increase in shoulder implants in active elderly patients has appeared in a parallel increase in periprosthetic humeral fractures. The aim of this study was to investigate the advantages of using strut grafting with plate fixation during periprosthetic humerus fractures. Methods Thirty patients diagnosed with periprosthetic humeral fracture were divided into two groups. The first group of 15 patients (PS) underwent plate, ring, screws and strut allografts. The second group with resting 15 patients (PWS) was treated with only plate and screws. The criteria to evaluate the groups during followup were the Constant Shoulder Score (CSS) and Oxford Shoulder Score (OSS); the bone healing was measured by X-rays, controls measured by radiographic union score (RUS), and complications. The follow up was terminated at 12nd month in both groups. Results The difference between the two groups in all parameters was not significant. However, all patients gained adequate shoulder motor skills for normal daily living activities. All fractures were healed. Only two complications were registered, and blood loss was minimal. Conclusion We believe a revision to reverse shoulder prosthesis with a long-stem implant with or without cortical strut allograft augmentation to be safe and appropriate in the management of these complex injuries, though technically challenging, and having good results for normal activities daily life.

Adult scoliosis: a quantitative radiographic and clinical analysis.

STUDY DESIGN: Prospective analysis of a consecutive series of adult patients with adolescent idiopathic scoliosis of the adult and de novo degenerative scoliosis. OBJECTIVES: To clinically and radiographically study two populations of adult patients with either adolescent idiopathic scoliosis of the adult or de novo degenerative scoliosis in a quantitative manner to identify reliable radiographic parameters that correlate with clinical symptoms. SUMMARY AND BACKGROUND: Although there are many causes of spinal deformity in the adult, there are two main categories of adult scoliosis: adolescent idiopathic scoliosis of the adult and de novo degenerative scoliosis. Unlike pediatric scoliosis, in adults there are no established radiographic parameters or classification systems that reliably provide a clinical correlation or offer a useful language for communication among specialists. This study gathered complete clinical and radiographic information on 95 patients with adult scoliosis and established several radiographic parameters that correlated with clinical symptoms. METHODS: Each of the 95 patients completed a clinical questionnaire that included a self-reported visual analog scale and underwent full-length standing anteroposterior and lateral radiography. Radiographic analysis was performed by use of digital analysis and included measurement of the Cobb angle, the number of vertebrae in each curve, plumbline offset from T1 to the midsacral line, the upper endplate obliquities of L3 and L4, and maximal lateral olisthy between two adjacent lumbar vertebrae. Sagittal plane measurements included lumbar lordosis, thoracolumbar kyphosis, and the Sagittal Pelvic Tilt Index. Statistical analysis of both radiographic and clinical parameters of pain was performed to determine any significant correlations between the two. RESULTS: This study showed that lateral vertebral olisthy, L3 and L4 endplate obliquity angles, lumbar lordosis, and thoracolumbar kyphosis were significantly correlated with pain. CONCLUSION: This quantitative analysis identified several clinically relevant radiographic parameters in adult scoliosis patients. Additionally, excellent predictive formulas for self-reported pain levels were obtained.